E-ISSN 1305-3612
Interventional Radiology - Original Article
Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: long-term follow-up results
1 Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea  
Diagn Interv Radiol ; : -

Abstract

PURPOSE: It is not easy to determine whether balloon angioplasty or stenting should be performed in patients with portal vein stenosis after liver transplantation. We aimed to propose appropriate indication by evaluating long-term outcomes of balloon angioplasty and stent insertion in adult liver transplant patients.


METHODS
: We retrospectively reviewed 31 patients with portal vein stenosis diagnosed in 1,369 patients who underwent adult liver transplantation from January 2001 to December 2015. When stenosis was confirmed by venography, angioplasty was performed first. When there was no flow improvement or pressure gradient was not decreased after angioplasty, stent insertion was performed. We also performed primary stent insertion without angioplasty for diffuse stenosis, kinking, external compression, and near occlusion of portal vein in venography. We assessed patency in patients who underwent PTA and stent insertion through regular outpatient follow-up and evaluated technical and clinical success and long-term results.


RESULTS
: Technical success was 85% and 100% in balloon angioplasty and stent insertion, respectively. Clinical success was achieved in 78% of balloon angioplasties and in 100% of stent insertions. At 1, 5, and 10 years after balloon angioplasty, patency rates were 87%, 82%, and 68% respectively, and the rates of stent patency were all 100%. Portal vein size measured during the operation of nonrecurrence patients and recurrence patients was 19 ± 4.2 mm and 19 ± 3.0 mm (P = 0.956), respectively. The balloon size of nonrecurrence patients and recurrence patients were 14 ± 1.66 and 11 ± 1.95, respectively (P = 0.013), when balloon angioplasty was performed after stenosis diagnosis.


CONCLUSION
: Stent insertion can be considered when fibrotic changes are expected due to repeated inflammation and when the balloon size to be used is small. Balloon angioplasty seems less risky for anastomotic ruptures in PVS in the early post-LT period.

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